How to Fill Out the FMCSA Medical Examination Report Form (MCSA-5875)

The MCSA-5875 Medical Examination Report Form is the health questionnaire and physical exam record used for a DOT physical. You complete Section 1 yourself — identification, health history, and medications — and a certified medical examiner completes the rest after examining you. A passing result leads to a Medical Examiner’s Certificate valid for up to two years, though several conditions shorten that window.1Federal Motor Carrier Safety Administration. Medical Examination Report (MER) Form, MCSA-5875

You can download the form from FMCSA’s website and fill out Section 1 at home before your appointment.2Federal Motor Carrier Safety Administration. MCSA-5875 Medical Examination Report Form Doing it at home saves time at the clinic and gives you the chance to pull medication names and diagnosis dates from your own records rather than trying to remember them under pressure.

Who Can Perform the Exam

The examiner must be listed on FMCSA’s National Registry of Certified Medical Examiners. You can find one near you through the registry’s search tool by entering your ZIP code and a distance radius.3Federal Motor Carrier Safety Administration. Search Medical Examiners An exam performed by anyone not on the registry is not valid, and no certificate issued from it will be recognized.

Costs generally run between $60 and $225 out of pocket. Most health insurance does not cover the exam, since it is an occupational requirement rather than preventive care. Call ahead to confirm price and whether the clinic accepts walk-ins.

What to Bring to the Appointment

  • A complete list of every prescription and over-the-counter medication you take, with dosages and prescribing doctor names.
  • Glasses, contact lenses, or hearing aids you use while driving.
  • If you have diabetes: your most recent hemoglobin A1C results and blood sugar logs. If you use insulin, also bring a completed Insulin-Treated Diabetes Mellitus Assessment Form (MCSA-5870) from your treating clinician, dated within 45 days of the exam.4Federal Motor Carrier Safety Administration. Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870
  • If you use CPAP for sleep apnea: at least 90 days of usage data downloaded from your machine, and if available, a letter from your sleep specialist.
  • If you have a heart condition, or a history of stroke, seizures, or brain injury: a letter from your cardiologist or neurologist describing your history, medications, and recent test results.
  • Your current commercial learner’s permit or commercial driver’s license, plus the license number and issuing state.

Filling Out Section 1: The Driver’s Portion

Section 1 is the only part of the form you complete yourself.2Federal Motor Carrier Safety Administration. MCSA-5875 Medical Examination Report Form It opens with identification: your full legal name, address, phone number, date of birth, driver’s license number, and issuing state. You also indicate whether you are a CLP applicant or a CDL holder. Make these details match your licensing records exactly. A mismatched name or license number can cause problems when the results are transmitted to your state.

The Health History Questions

The form lists 32 specific conditions. For each, you check “yes,” “no,” or “not sure.” The list is wide: head or brain injuries, seizures, dizziness, heart disease, high blood pressure, lung conditions, kidney problems, diabetes, muscle and bone disorders, psychiatric conditions, and substance use, among others.

Every “yes” or “not sure” answer needs a written explanation in the comments area. Include when you were diagnosed, what treatment you receive, and whether the condition is currently controlled. Vague answers slow the process down, because the examiner will need to ask follow-up questions anyway.

The Medication List

List every medication you take, the dosage, and who prescribed it. The examiner cross-checks this list against your health history answers. A blood pressure medication with no corresponding “yes” on the hypertension question is the kind of gap that gets flagged.

After the health history and medication list, you sign and date the form, certifying that everything you reported is accurate and complete.

Why Truthful Answers Matter

Deliberately omitting a condition or giving false answers can invalidate the entire examination and any certificate issued from it. FMCSA may also impose a civil penalty under 49 U.S.C. 521(b)(2)(B) for a false statement or for concealing a disqualifying condition.5Federal Motor Carrier Safety Administration. What Happens if a Driver Is Not Truthful About His/Her Health History on the Medical Examination Form Many conditions that sound disqualifying on paper have exemption pathways or monitored-certification options, so hiding something usually creates more risk than disclosing it.

What the Examiner Does in Section 2

After going over your health history and any flagged answers, the examiner performs the physical and records the findings. This section is entirely the examiner’s responsibility, but knowing the tests helps you prepare.

Vision and Hearing

Federal standards require at least 20/40 distant visual acuity in each eye (with or without correction), at least 70 degrees of horizontal field of vision in each eye, and the ability to recognize red, green, and amber traffic signal colors. For hearing, you must perceive a forced whisper at five feet in your better ear, or pass an audiometric test showing no more than 40 decibels average hearing loss at 500, 1,000, and 2,000 Hz.6eCFR. 49 CFR 391.41 – Physical Qualifications for Drivers Hearing aids and corrective lenses are permitted.

Drivers who cannot meet the vision standard in one eye (monocular vision, for example) no longer need a separate federal vision exemption. As of March 2022, an alternative vision standard replaced the old exemption program, and qualifying drivers have the examiner complete a Vision Evaluation Report (Form MCSA-5871) as part of the physical.7Federal Motor Carrier Safety Administration. General Vision Exemption Package

Blood Pressure

Blood pressure is one of the most common reasons a driver receives a shortened certificate. The regulation itself only disqualifies high blood pressure “likely to interfere” with safe operation, but examiners follow FMCSA’s advisory tiers in practice:8Federal Motor Carrier Safety Administration. Section 391.41(b)(6) – Driver Safety and Health Medical Requirements

  • Below 140/90: full two-year certificate.
  • 140–159/90–99 (Stage 1): one-year certificate.
  • 160–179/100–109 (Stage 2): a one-time three-month certificate; if readings drop below 140/90 within that window, a one-year certificate can be issued.
  • 180/110 or higher (Stage 3): disqualified until readings come below 140/90, then eligible for six-month certificates.

Drivers already diagnosed with hypertension and on treatment should expect annual certifications at most, even with a good reading on exam day.

Urinalysis and Physical Assessment

The examiner collects a urine sample and tests for specific gravity, protein, blood, and sugar. Abnormal results do not automatically disqualify you, but may prompt additional testing. A head-to-toe physical assessment follows, and any abnormality is noted with a comment on whether it affects safe operation of a commercial vehicle.

Conditions That Need Extra Documentation

Some conditions do not disqualify you outright but do require paperwork beyond the MCSA-5875 itself.

Insulin-treated diabetes. Drivers who use insulin can qualify under 49 CFR 391.46. Certification is limited to 12 months and requires the MCSA-5870 assessment, completed by a treating clinician within 45 days of the exam, attesting to a stable insulin regimen and controlled blood sugar.6eCFR. 49 CFR 391.41 – Physical Qualifications for Drivers

Sleep apnea with CPAP. There is no formal regulation setting compliance thresholds, but examiners generally look for at least four hours of CPAP use per night, at least 70 percent of the time. Ninety days of downloaded compliance data is the usual expectation. Drivers new to CPAP may be certified after a minimum of one week of documented successful use, typically on an annual recertification schedule.

Loss or impairment of a limb. A driver with the loss or impairment of a hand, finger, arm, foot, or leg needs a Skill Performance Evaluation (SPE) certificate to drive in interstate commerce. The process involves an on-road and off-road driving test, and applications go to the FMCSA Service Center for your region.9Federal Motor Carrier Safety Administration. Skill Performance Evaluation Certificate Program

The Examiner’s Determination

After the physical, the examiner marks one of five determinations on the form:10Federal Motor Carrier Safety Administration. Medical Examiners Handbook 2024 Edition

  • Meets standards, two-year certification: you pass with no restrictions beyond any corrective lenses or hearing aids noted.
  • Meets standards with periodic monitoring: you qualify, but the certificate is shortened to a specific period, with the reason documented.
  • Determination pending: the examiner needs more information or further testing. You have 45 days to provide records or return.
  • Does not meet standards: disqualified, with the reason documented.
  • Incomplete examination: the exam was not finished, for example if you left before it was completed.

The examiner signs and dates the form, records their National Registry number, and, for drivers who pass, issues the Medical Examiner’s Certificate (Form MCSA-5876).

How Your Results Reach the State

The examiner must upload your results to the National Registry by midnight local time of the calendar day after the exam.11Federal Motor Carrier Safety Administration. National Registry of Certified Medical Examiners That is faster than many drivers expect. If you want to confirm the submission went through, call the examiner’s office within a day or two.

As of June 23, 2025, CLP applicants and CDL holders no longer submit a paper medical card to their State Driver Licensing Agency. The National Registry transmits your results electronically to the SDLA, which posts them to your driving record. The paper MCSA-5876 from your examiner is no longer official proof of medical certification for CDL and CLP holders; the electronic record on your driving record is.12Federal Motor Carrier Safety Administration. National Registry II Requirements Drivers who operate commercial vehicles that do not require a CDL or CLP still receive a paper certificate and should keep it in the vehicle.

CDL holders also self-certify their operating category with the SDLA. Most interstate drivers fall under Non-Excepted Interstate, which requires a current medical certificate on file. If you operate in both excepted and non-excepted interstate commerce, you must certify as non-excepted.13Federal Motor Carrier Safety Administration. How Do I Determine Which of the 4 Categories of Commercial Motor Vehicle (CMV) Operation I Should Self-Certify to With My State Driver Licensing Agency (SDLA)?

Renew Before Your Certificate Expires

If your certificate lapses, your SDLA must change your status to “not certified” and begin CDL downgrade procedures within 60 days of receiving notice of the expiration or of a loss of medical qualification.14eCFR. 49 CFR 391.45 – Persons Who Must Be Medically Examined and Certified A downgraded license loses its commercial privileges, and you cannot legally drive a CMV until you pass a new DOT physical and your certification is restored on your record. Schedule the renewal exam well before the current certificate runs out.